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ENVIRONMENTAL HEALTH DEPARTMENT raye 600 E MAIN STREET STOCKTON, CA 95202 Phone: (209) 468-3420 INVOICE $ 3 3 Account ID AR0003169 Immonommmmmmml Facility ID F FA000359 LUMMMMMMOMMMA Date Printed 5/27/2009 HARRINGTON, JAMES RE : JIMS 24 HOUR GAS N GO" JIMS 24 HOUR GAS N GO" 8203 E HWY 26 4111 CLARINBRIDGE CIR STOCKTON, CA 95215-9536 DUBLIN, CA 94568 OWNER : JAMES MICHAEL & ASSOCIATES Date Health Program Description Amount Invoice# IN0183905---Date of Invoice : 1/29/2009 llllllll VIII VIIIIII1Ii11IIIVII IIIIIIIiIVIIllil 11111111111111111111111 1/29/2009 2220 SM HW GEN<5 TONS/YR $ 213.00 1/29/2009 2244 2009 HAZMAT FEE $ 100.00 1/29/2009 2301 UST STATE SURCHARGE FEE $ 15.00 1/29/2009 2301 UST STATE SURCHARGE FEE $ 15.00 1/29/2009 2301 UST STATE SURCHARGE FEE $ 15.00 1/29/2009 2360 ADDITIONAL UST $ 125.00 1/29/2009 2360 ADDITIONAL UST $ 125.00 1/29/2009 2362 UST FACILITY& 1 TANK $ 550.00 1/29/2009 2399 UNIFIED PROGRAM FAC STATE SURCHARGE FEE $ 24.00 3/15/2009 9987 Haz Mat Program Penalty Fee $ 10.00 4/15/2009 9994 PERMIT FEE PENALTY $ 213.00 4/15/2009 9994 PERMIT FEE PENALTY $ 550.00 4/15/2009 9994 PERMIT FEE PENALTY $ 125.00 4/15/2009 9994 PERMIT FEE PENALTY $ 125.00 Total for this Invoice $ 2,205.00 PAST DUE TOTAL DUE this Billing Period $ 2,205.00 rA Delinquent charges will be foRvarded to COLLECTIONS in 30 days, �. Please make Checks PAYABLE to: 'EHD' — Return a Copy of This STATEMENT with Your PAYMENT Penalties will be added to all Permit Fees For DES/HMMP Fees For all SERVICE FEES at the Rate of 100%of the Base Fee Penalties will be added at the Rate of 10% Penalties will be added at the Rate of 10 30 Days after the Due Date 45 Days after the Invoice Date 60 Days after the Invoice Date and each 30 Days thereafter 5254 rpt